IU Northwest News

Opioid addiction: A Grand Challenge for Indiana, and, its universities

The rise of opioid dependence has created an urgent problem that begs the need for more programs, experts, jobs

Wednesday Dec 12, 2018

IU responds to a Grand Challenge with more than 30 projects to tackle opioid crisis

Opioid addiction is such an urgent problem in Indiana, that fighting it has become one of three initiatives supported by Indiana University’s Grand Challenges Program, a collaborative effort to address large-scale, complex problems facing the entire state.

As part of the Responding to the Addictions Crisis grand challenge, in 2017, IU President Michael A. McRobbie committed to investing $50 million in community partnerships to prevent and reduce statewide addiction, with more than 30 projects receiving funding to date. Areas of focus range from how opioid addiction impacts the labor market, to examining the stigma of addiction, to educating first responders in overdose-reversal training, and more.

Drawing from its world-class faculty researchers and taking advantage of its community and industry partnerships, IU is executing one of the nation’s largest and most comprehensive state-based responses to the opioid addiction crisis—and the largest led by a university.

Part I:

Opioid addiction is a crisis across the nation. Indiana University is leading the way in the battle to fight the epidemic in the Hoosier state. Through its Grand Challenges Program, the university has committed to investing $50 million to collaborate with community partners across the state to prevent and reduce addictions.

The problem brings to light another developing need that needs IU’s attention. With addiction comes the need for addiction professionals. While opioid addiction is a pervasive problem, and one of the most common reasons that people need intervention, addiction is a disease that affects everyone. Preparing a pool of professionals who are experts in treating addiction has become a priority of IU Northwest, which resides in a region that needs more resources.

This two-part series explores one man’s personal journey and a developing profession, as well as what IU and IU Northwest are doing to enhance the quality of life of the most diverse, urban, industrialized region of the state.

* * *

When Rodrigo Garcia, a nurse anesthetist, had surgery for a broken ankle, he received a prescription for hydrocodone, an opioid. The one or two tablets that were recommended to control his pain didn’t quite take the edge off.

Because he was a nurse who could prescribe the medication, he knew how much he could really take.

“I rationalized that I knew how to administer it and I had a prescription for it,” he said. “It says take one or two, but three or four worked a little bit better. So that is how it started.”

From there, it only took a couple of months to become physically dependent on the medication, and as a health care provider, he had easy access.

“That is what I did for a living. I gave opioids to my patients,” Garcia said, “so it wasn’t long before that line got blurred at work. It was all legitimate. I had pain, I had a prescription. This went on for quite some time.”

Then, Garcia’s employer began noticing he was “just not right” at work. They suspected him of diverting medication. They ordered him into what was then the Indiana State Nurses Assistance Program (ISNAP) and for the next year, Garcia had to check in each day and submit random drug screens.

He finished that year of monitoring successfully, but within a few months, he had relapsed and was diverting pills once again. This time, the hospital fired him and reported him to the attorney general’s office and the nursing board.

A widespread problem: The cost to the nation

Garcia’s story is heartbreakingly common.

More than 11.4 million people have misused prescription opioids since 2016, leading the nation to a public health emergency as declared by the U.S. Department of Health and Human Services in 2017. One in 12 of those are health professionals, according to the American Nurses Association.

The roots of the crisis date back to the late 1990s, according to the National Institute for Drug Abuse, “when pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medicines before it became clear that these medications could indeed be highly addictive.”

As Garcia’s story proves, it is easy to see how a couple of extra pain pills can spiral out of control.

In 2017, 1,700 Hoosiers died from drug overdose. That’s an all-time high, and a 75 percent increase since 2011, according to the IU Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis (IUPUI). The crisis has cost Indiana an estimated $4.3 billion over the past 15 years, stemming from lost productivity and direct damages such as hospitalizations, incarceration, treatment of neonatal abstinence syndrome and foster care.

The need for professionals in the region

As the opioid crisis deepens, and lawsuits emerge against the drug makers who many blame for the crisis, so does the need for qualified addiction professionals. In fact, the Bureau of Labor Statistics expects a 23 percent growth rate over the next eight years for careers in substance abuse, behavioral disorder and mental health.

In a recent report on Indiana’s opioid crisis, the Fairbanks School of Public Health listed training of more medical and behavioral specialists as one recommendation for addressing the crisis. It also found an enormous amount of unmet need for Indiana residents who suffer from substance abuse disorders. Northwest Indiana is one region that has scant resources, begging the need for more professionals, not only to treat individuals, but to develop treatment centers.

A vision to help: A graduate program is born

Mark Hoyert, now dean of the College of Arts and Sciences, envisioned bringing an alcohol and substance abuse training program to campus. For years, he taught a course entitled “Drugs and the Nervous System” that was a popular way for working professionals to earn their continuing education credits.

"While addictions can be devastating for the affected, they are also treatable. Many mental health service providers in the region offer addictions counseling and employ hundreds of therapists. All of these counselors will need basic education, continuing education and credentialing." - Mark Hoyert

He knew that the field was undergoing professionalization and that the licensing agencies were beginning to change their expectations for treatment professionals. Soon, there would be a legal mandate for more formal training.

The first step for IU Northwest to address this need was getting approval to offer a post-baccalaureate certificate in addiction counseling, which it did for several years.

Hoyert began pushing harder to bring a full graduate program to IU Northwest, noting that both the National Association of Alcoholism and Drug Abuse Counselors (NAADAC) and the National Institute on Drug Abuse (NIDA) were recommending a minimum of master’s degree-level training for drug and alcohol counselors. The state had also adopted changes in licensing regulations that would require a clinical addictions counselor to receive a master's or doctor's degree in addiction counseling.

Now educating its seventh cohort, and headed by Mary Ann Fischer, IU Northwest’s program is designed for students who wish to prepare for careers in addiction counseling. The coursework and experiential opportunities help candidates qualify for the Licensed Clinical Addictions Counselor credential in the state of Indiana. Students are required to work 750 hours in agencies around Northwest Indiana before they graduate. They fulfill this in private practices, community health centers, jails and correction centers.

“I’m very proud that the graduates of our MSCC program are able to contribute to efforts to meet these needs in Northwest Indiana,” Fischer said. “Our graduates work in a variety of settings, bringing both empathy and professionalism to their work as well as the ability to apply a variety of evidence-based treatments and counseling techniques.”

A ripple effect: Helping the region thrive

With a strong, highly trained group of graduates working in the region, IU Northwest’s MSCC program is addressing the opioid crisis and bringing hope to local communities, one person at a time.

Oftentimes, a personal experience with addiction is what leads individuals to a career in drug and alcohol counseling. Rodrigo Garcia is one example. When he finally emerged from his opioid addiction, it changed him.

The first time, he failed because he was required to be monitored, but no one required him to undergo treatment. Fortunately, he was given a second chance, because treatment is such a critical piece. Without it, he was doomed to fail. So Garcia began his journey anew.

“When I walked into treatment, there were 30 people just like me,” Garcia said. “They were doctors and nurses, pilots and pharmacists, and business people. I had never heard of a professionals program. I instantly felt welcome. I quickly realized that I never would have stayed sober without this. The monitoring component is step two, or three or four. Without treatment, nothing will matter.”

This was the epiphany that led to big things happening not only for Garcia, but also others like him across Northwest Indiana.

After this experience, Garcia returned to his nurse anesthetist career, but with an important new purpose. His wife, Claudia, was an IU Northwest-prepared nurse, who stood by Garcia’s side through the ordeal. While Garcia was spending his sober year off work, they both earned their Master of Business Administration degrees with the goal of opening a treatment center.

David Cummins, an addiction physician educated at IU School of Medicine, joined them as medical director. They opened Parkdale Treatment Center in Chesterton in 2015 and began working with all the agencies that were investigating Garcia as well as the monitoring program.

Coming in Part II:

The treatment center born out of Garcia’s crisis is thriving, IU Northwest’s program continues to evolve, and IU Northwest graduates are on the front lines of a sister company charged with protecting the public.